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The COVID-19 pandemic has forced school closure thus shifting teaching and learning towards full home-based learning (HBL). Technology plays a key role but the considerations to design online learning environments that meaningfully engage students are complex. This exploratory, qualitative study attempted to elicit eight mathematics teachers' considerations and perspectives in designing online home-based learning lessons for the engagement of elementary and secondary students. Data were gathered through interviews. Ground-up thematic analyses were conducted. The following implications are derived--(1) student engagement in online learning context is paramount to their learning, (2) there is no one software application for all the learning activities, (3) teacher professional development is necessary to keep them up-to-date, (4) online social networking platforms may be necessary for students' discussion beyond official online lesson time, and (5) students need to be inculcated with more self-directed skills and habits for learning in online and face-to-face contexts. This study gathers evidence-informed considerations for teachers to design lessons and engage students meaningfully in a unique, online HBL environment. While this is an exploratory study, future studies can inform this area of work by including more teachers across subjects, grades, schools, and geographical contexts. Studies involving students and parents would also be meaningful.

The proliferation of information and communication technology (ICT) has changed the way we live and this also has implications on how it is used for learning and entertainment. However, technology and digital media are more often seen as gateways to entertainment and the attraction is a very strong one. This is true for adults and children including pre-schoolers. This online survey research investigated parents' attitudes and concerns towards their pre-schoolers' use of technology and digital media in Singapore. More specifically, this survey research explored parents' attitudes towards the 'what' and 'why' questions of pre-schoolers' use of technology and digital media at home; what technological devices were more commonly used, what digital media activities were pre-schoolers mostly engaged in (i.e., learning or entertainment) and why technology and digital media were used. Parents were also surveyed if they were concerned about some perceived effects of their pre-schooler's digital media use. Although parents rated and ranked improving their pre-schoolers' skills and knowledge as the highest in terms of importance of digital media use, the findings of the survey reflected that the amount of time their pre-schoolers use technology and digital media for entertainment is significantly more than that for learning.

Continuous professional development is necessary for teachers to stay current with teaching and learning. However, teachers face tensions when they engage in such activities. From the sociocultural and distributed leadership perspectives, this case study investigates how a school, recognised for its excellence in staff well-being and development, reconciles such tensions. The systematic and efficient school administration and distributed leadership empower teachers to plan and chart their own professional development activities. It is evident that teachers from the school are empowered via open communication with their respective teacher coordinators to plan and chart their professional development. Relevance and practical use of content of professional development are most important to teachers. More time and resources have been devoted for better quality training for teachers. There is also a shift towards network learning communities where teachers learn from one another within the school and across schools, although teachers still attend courses.

Physical activity (PA) levels may have changed since the COVID-19 pandemic. However, these changes are not well understood. The study aimed to describe the PA level and examine the predictive factors of a health-enhancing PA level among working women in Singapore two years into the COVID-19 pandemic. We undertook a cross-sectional descriptive correlational study. Three hundred participants were recruited and completed the online questionnaire between October and November 2021. In the PA analysis of 217 participants, only 32.7% of the participants achieved a health-enhancing PA level, while 44.7% of the total sample sat for 7 h or more daily. In the univariate analysis, occupation, nationality, monthly income, and average daily sitting hours were significantly associated with a high PA level. The current mode of work, living arrangement, and health-promoting lifestyle profile II_physical activity score remained significant in both univariate and multivariate analyses. Participants who worked from home and stayed with their families were less likely to achieve a health-enhancing PA level than those who had a regular workplace and did not stay with their families. Working women with a health-promoting physically active lifestyle were likelier to achieve a health-enhancing PA level. The long daily sitting time and suboptimal health-enhancing PA participation underscore the need for health promotion initiatives for working women. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a nurse‐led smartphone‐based self‐management programme (NSSMP) on improving self‐efficacy, promoting diabetes self‐care, increasing health‐related quality of life (HRQoL) and decreasing HbA1c, acute complications and unplanned medical consultation for people with poorly controlled type 2 diabetes compared with a nurse‐led diabetic service (NDS). Design A two‐arm randomized controlled trial with repeated measures was conducted. Methods: Participants were recruited from June 2018 to September 2020. Eligible participants were assigned to either the intervention or control group randomly. Participants assigned to intervention group received the 6‐month NSSMP, while those in the control group received existing NDS provided by the study hospital. Outcomes were measured at baseline, and at 3 and 6 months from baseline. Results: A total of 114 participants were recruited. There were no significant interactions between group and time for all the outcomes except for blood glucose testing activities (F = 4.742, p =.015). Both groups had reduced HbA1c over 6 months. The intervention group had a lower HbA1c than the control group at follow‐ups, but the differences were not statistically significant. None of the participants had acute diabetes complications at follow‐up. Similarly, the differences in the number of unplanned medical consultation at 6‐month follow‐up between two groups were statistically insignificant. Conclusion: The NSSMP is as effective as existing NDS provided by the study hospital in improving most of the outcomes. NSSMP can liberate valuable time for nurses to provide care to critically ill patients and supports healthcare resource constraints in the current COVID‐19 pandemic. Impact The existing diabetes service is labour intensive as nurses are required to deliver education, follow‐up telephone calls to trace blood sugar monitoring and provide therapeutic consultations and necessary referrals. The outbreak of COVID‐19 pandemic has added further strain on the overworked professionals. NSSMP provides an alternative programme that is just as effective, to reduce nurses' workload by delegating them back to the individuals through self‐management strategies. This enables nurses to increase contact time with patients, and individuals to take onus of their disease through increased self‐efficacy, facilitated by technology. Clinical Trial: This study is registered under clinical registration number NCT03088475. [ABSTRACT FROM AUTHOR]

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients. [ABSTRACT FROM AUTHOR]

Tourism contributes to the growth of economy of a nation through employment, multiplier effect, and foreign exchange earnings and also contributes to positive balance of payments. Therefore, developed and developing countries have incorporated tourism into their long-term economic development planning. However, tourism is vulnerable to crisis events, such as outbreaks, political turmoil and also financial crisis. This study examines the performance of tourism sector in Indonesia, Malaysia, and Singapore with regard to the recent global crisis. The three countries are chosen because of several reasons. Firstly, they have incorporated tourism as one of the focuses in their long-term economic development plan. Secondly, although they are closely related in terms of geographic proximity and regional cooperation, they differ in terms of size and openness of economy. All the commonalities and differences make it more intriguing to carry out the study. This study employs ordinary least squares method to investigate the significance of tourism in relation to economic growth. There are two models used in this study. First model employs GDP to represent economic growth and the number of international tourist arrival to represent tourism growth. Second model employs hotel's rate of occupancy, average length of stay, and the number of tourist arrival as proxy of tourism growth. Comparative study is also done in the discussion in order to analyze how the respective countries differ in tourism performance. The study finds out that for the three countries, tourism is of significance for the economic growth. Tourism was also affected by financial crisis, as seen from the short dip in the performance of the tourism sector in terms of the number of tourist arrival and hotel's rate of occupancy in first quarter of 2009. Nevertheless, the sector is considered as a resilient sector as it successfullyrecovered in 2010a. Based on the comparison, it is found that Singapore is affected much in comparison with the other two. It may be linked to strong real effective exchange rate, which makes the price less competitive compared to the other two. This study also finds that regional tourists actually play an important role in the development of tourism, because they comprise the largest portion of tourist arrival compared to outside-regional tourists, and the number has remained stable. Based on the result obtained, we consider tourism development as one of strategic economic pillars since it has significantly positive impact on GDP growth. We also deliberate that the countries should focus on catering to the preferences of regional tourists to accelerate the growth of this sector. [ABSTRACT FROM AUTHOR]

The industrial revolution followed by globalization and multi-nationalization of businesses has enhanced the need for best practices of corporate governance. This paper examines the influence of corporate governance practices on earnings management. Specifically, the core objective of this study is to test whether the roles of board of directors and other key committees influence Earnings Management (EM) through Discretionary Accruals (DAC). This study has analyzed the governance practices of 326 companies listed in the Singapore stock exchange by using the observations of two years. The structural model linking the corporate governance practices and EM through DAC has been tested using Lisrel 9.1 student version. The key findings of the study are: (1) the chances of recording discretionary accruals are high if the board size is big implying that higher control can lead to better management. These controls must come through appointment of more independent directors for Boards that are big; (2) board independence, segregation of duties between the CEO and chairman, sizes of the audit committee and nomination committee have significant positive influence on board size; (3) the nomination committee influences the remuneration committee directly implying that the motivation for recording discretionary accruals is higher leading to higher possibilities of earnings management; and (4) board size mediates the relationship between corporate governance practices (board independence, segregation of duties between CEO and chairman, audit committee size and nomination committee size) and EM through DAC implying that board size is crucial to effect better control. We accentuate that segregation of responsibilities between the remuneration committee and the nomination committee, when the Board size is big, will reduce earnings management through discretionary accruals. These governance practices will reduce the agony of stakeholders due to broken trust. The findings are pertinent to Asian countries where the institutional investors have a very small role to play. The onus of protecting the minority shareholders and foreign investors are in the hands of insiders. This requires effective corporate governance practices. The regulatory bodies must ensure that the practices of good governance are strictly adhered to. [ABSTRACT FROM AUTHOR]

• The potential of implementing management strategies in reducing waste-related greenhouse gas emissions was evaluated. • Three kinds of waste – food, sewage, and plastic were analysed was evaluated using life cycle assessment. • By diverting plastic waste away from incineration, the reduction in GHG emission is 61%. • By diverting food waste away from incineration, GHG emission amount is reduced to 54.69 % of the emission from BAU method. • The GHG emission of sewage sludge and food waste co-digestion reduces the current emission (incineration) by 64.3%. The potential of implementing waste recovery strategies on three kinds of waste – food, sewage, and plastic – in reducing waste-related greenhouse gas emissions in Singapore was evaluated using life cycle assessment. It was found that the proposed strategies are capable of reducing 1,087.80 kgCO 2 -eq per tonne of plastic waste, 53.00 kgCO 2 -eq per tonne of food waste, and 43.86 kgCO 2 -eq for the combination of one tonne of sewage waste and one tonne of food waste. When uncertainties of the three waste streams were considered in sensitivity analysis and projections of waste quantities to 2025 were performed up to a 95% confidence level, it was found that the proposed strategies could reduce about 37.13% of the GHG emissions from the business-as-usual disposal waste technology (that is, incineration). This corresponds to an average reduction of 0.53 million tonnes CO 2 -eq per year, which is equivalent to the annual GHG emissions from electricity consumptions of 256,322 households in Singapore. Graphical Abstract [Display omitted]. [ABSTRACT FROM AUTHOR]

This paper aims to evaluate the life cycle greenhouse gas (GHG) emissions of importing electrical power into Singapore, generated from a large-scale solar photovoltaic (PV) power plant in Australia, through a long-distance subsea high-voltage direct current (HVDC) cable. A cost optimization model was developed to estimate the capacities of the system components. A comprehensive life cycle assessment model was built to estimate emissions of manufacturing and use of these components. Our evaluation shows that, for covering one fifth of Singapore's electrical energy needs, a system with an installed capacity of 13 G W P V , 17 GWh battery storage and 3.2 G W subsea cable is required. The life cycle GHG emissions of such a system are estimated to be 110 g CO 2 eq/ kWh , with the majority coming from the manufacturing of solar PV panels. Cable manufacturing does not contribute largely toward GHG emissions. By varying full-load hours and cable lengths, it was assessed that sites closer to Singapore might provide the same energy at same/lower carbon footprint and reduced cost, despite the lower insolation as compared to Australia. However, these sites could cause greater emissions from land use changes than the deserts of Australia, offsetting the advantages of a shorter HVDC cable. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a major public health problem that places a significant disease burden on society. Self-care is important in the management of HF because it averts disease progression and reduces the number of hospitalizations. Effective nursing interventions promote HF self-care.Objective: This study aims to explore participants' perspectives on a nurse-led, home-based heart failure self-management program (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness of the study intervention.Methods: A descriptive, qualitative approach was used. English- or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semistructured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed verbatim, with the participant identifiers omitted to ensure confidentiality. The thematic analysis approach was used to identify, analyze, and report patterns (themes) within the data.Results: A total of six themes emerged from the process evaluation interviews and were categorized according to the Donabedian structure-process-outcome framework as intervention structure, intervention process, and intervention outcome. These six themes were manageability of the intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care.Conclusions: The findings of the process evaluation provided additional information on participants' perceptions and experiences with the HOM-HEMP intervention. Although a home visit may be perceived as resource intensive, it remains to be the preferred way of engagement for most patients. Nurses play an important role in promoting HF self-care. The process of interaction with the patient can be an important process for empowering self-care behavior changes. [ABSTRACT FROM AUTHOR]

Background: High utilizers (HUs) are a small group of patients who impose a disproportionately high burden on the healthcare system due to their elevated resource use. Identification of persistent HUs is pertinent as interventions have not been effective due to regression to the mean in majority of patients. This study will use cost and utilization metrics to segment a hospital-based patient population into HU groups.Methods: The index visit for each adult patient to an Academic Medical Centre in Singapore during 2006 to 2012 was identified. Cost, length of stay (LOS) and number of specialist outpatient clinic (SOC) visits within 1 year following the index visit were extracted and aggregated. Patients were HUs if they exceeded the 90th percentile of any metric, and Non-HU otherwise. Seven different HU groups and a Non-HU group were constructed. The groups were described in terms of cost and utilization patterns, socio-demographic information, multi-morbidity scores and medical history. Logistic regression compared the groups' persistence as a HU in any group into the subsequent year, adjusting for socio-demographic information and diagnosis history.Results: A total of 388,162 patients above the age of 21 were included in the study. Cost-LOS-SOC HUs had the highest multi-morbidity and persistence into the second year. Common conditions among Cost-LOS and Cost-LOS-SOC HUs were cardiovascular disease, acute cerebrovascular disease and pneumonia, while most LOS and LOS-SOC HUs were diagnosed with at least one mental health condition. Regression analyses revealed that HUs across all groups were more likely to persist compared to Non-HUs, with stronger relationships seen in groups with high SOC utilization. Similar trends remained after further adjustment.Conclusion: HUs of healthcare services are a diverse group and can be further segmented into different subgroups based on cost and utilization patterns. Segmentation by these metrics revealed differences in socio-demographic characteristics, disease profile and persistence. Most HUs did not persist in their high utilization, and high SOC users should be prioritized for further longitudinal analyses. Segmentation will enable policy makers to better identify the diverse needs of patients, detect gaps in current care and focus their efforts in delivering care relevant and tailored to each segment. [ABSTRACT FROM AUTHOR]

Background: As healthcare expenditure and utilization continue to rise, understanding key drivers of hospital expenditure and utilization is crucial in policy development and service planning. This study aims to investigate micro drivers of hospital expenditure and length of stay (LOS) in an Academic Medical Centre.Methods: Data corresponding to 285,767 patients and 207,426 inpatient visits was extracted from electronic medical records of the National University of Hospital in Singapore between 2005 to 2013. Generalized linear models and generalized estimating equations were employed to build patient and inpatient visit models respectively. The patient models provide insight on the factors affecting overall expenditure and LOS, whereas the inpatient visit models provide insight on how expenditure and LOS accumulate longitudinally.Results: Although adjusted expenditure and LOS per inpatient visit were largely similar across socio-economic status (SES) groups, patients of lower SES groups accumulated greater expenditure and LOS over time due to more frequent visits. Admission to a ward class with greater government subsidies was associated with higher expenditure and LOS per inpatient visit. Inpatient death was also associated with higher expenditure per inpatient visit. Conditions that drove patient expenditure and LOS were largely similar, with mental illnesses affecting LOS to a larger extent. These observations on condition drivers largely held true at visit-level.Conclusions: The findings highlight the importance of distinguishing the drivers of patient expenditure and inpatient utilization at the patient-level from those at the visit-level. This allows better understanding of the drivers of healthcare utilization and how utilization accumulates longitudinally, important for health policy and service planning. [ABSTRACT FROM AUTHOR]

Explores the importance of guidelines and mechanisms for informed consent in clinical trials in Singapore. Primary concerns of informed consent; Overview of a scenario that illustrates the vulnerability of the principle of informed consent; Role of the Singapore Research Ethics Committee.

Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons. A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235). A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline. Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up. The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore. [ABSTRACT FROM AUTHOR]

The policies and practices for obtaining informed consent from research subjects in clinical research play a vital role in determining a nation's success as a center for clinical research. The difficulty lies in the fact that while on the one hand, informed consent is a necessary pre-condition for ethical clinical research, a scrupulous observance of the guidelines for informed consent could, on the other hand, cripple medical research. Crippling of ethical medical research can be adverse to public interest, and consequently, unethical. Hence, a fine balance must be struck in the application of the guidelines for obtaining informed consent. This, in turn, would depend on the constitution and skill of research ethics committees who are appointed to consider and approve clinical research proposals. The discussion below addresses the above difficulty with recommendations that could further enhance Singapore's image as a regional clinical trial hub.